Organization Active NPI

Compassionate Community Physicians PC

  • Internal Medicine Physician
  • Forest Hills, NY
National Provider Identifier
1003441429
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COMPASSIONATE COMMUNITY PHYSICIANS PC
Practice address
6861 Yellowstone Blvd Apt 116
Forest Hills, NY 11375-3371
Phone
(347) 689-8880
NPI assigned
Mar 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ilya Kleyn, MDNPI 1851327092
Title
MD
Phone
(347) 689-8880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

6861 Yellowstone Blvd Apt 116
Forest Hills, NY 11375-3371

Mailing address

6861 Yellowstone Blvd Apt 116
Forest Hills, NY 11375-3371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200513001881 NY Part B Supplier - Clinic/Group Practice 4183055882 Receives reassigned benefits from 3 practitioners
Practice locations: Forest Hills, NY

National Provider Directory

National Provider Directory

Locations

1131 Jericho Tpke
Commack, NY 11725

300 W Hills Rd
Huntington Station, NY 11746
Phone (631) 629-8708

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1003441429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6861 YELLOWSTONE BLVD APT 116",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6861 YELLOWSTONE BLVD APT 116",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753371",
            "telephone_number": "347-689-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPASSIONATE COMMUNITY PHYSICIANS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "KLEYN",
        "authorized_official_first_name": "ILYA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "347-689-8880",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.